Clinical effectiveness of patellar resurfacing, no resurfacing and selective resurfacing in primary total knee replacement:systematic review and meta-analysis of interventional and observational evidence

BACKGROUND: Patellar resurfacing is optional during total knee replacement (TKR). Some surgeons always resurface the patella, some never resurface, and others selectively resurface. Which resurfacing strategy provides optimal outcomes is unclear. We assessed the effectiveness of patellar resurfacing, no resurfacing, and selective resurfacing in primary TKR. METHODS: A systematic review and meta-analysis was performed. MEDLINE, Embase, Web of Science, The Cochrane Library, and bibliographies were searched to November 2021 for randomised-control trials (RCTs) comparing outcomes for two or more resurfacing strategies (resurfacing, no resurfacing, or selective resurfacing) in primary TKR. Observational studies were included if limited or no RCTs existed for resurfacing comparisons. Outcomes assessed were patient reported outcome measures (PROMs), complications, and further surgery. Study-specific relative risks [RR] were aggregated using random-effects models. Quality of the evidence was assessed using GRADE. RESULTS: We identified 33 RCTs involving 5,540 TKRs (2,727 = resurfacing, 2,772 = no resurfacing, 41 = selective resurfacing). One trial reported on selective resurfacing. Patellar resurfacing reduced anterior knee pain compared with no resurfacing (RR = 0.65 (95% CI = 0.44–0.96)); there were no significant differences in PROMs. Resurfacing reduced the risk of revision surgery (RR = 0.63, CI = 0.42–0.94) and other complications (RR = 0.54, CI = 0.39–0.74) compared with no resurfacing. Quality of evidence ranged from high to very low. Limited observational evidence (5 studies, TKRs = 215,419) suggested selective resurfacing increased the revision risk (RR = 1.14, CI = 1.05–1.22) compared with resurfacing. Compared with no resurfacing, selective resurfacing had a higher risk of pain (RR = 1.25, CI = 1.04–1.50) and lower risk of revision (RR = 0.92, CI = 0.85–0.99). CONCLUSIONS: Level 1 evidence supports TKR with patellar resurfacing over no resurfacing. Resurfacing has a reduced risk of anterior knee pain, revision surgery, and complications, despite PROMs being comparable. High-quality RCTs involving selective resurfacing, the most common strategy in the UK and other countries, are needed given the limited observational data suggests selective resurfacing may not be effective over other strategies. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12891-022-05877-7

Novel and Flexible Entries into Prostaglandins and Analogues Based on Ring Closing Alkyne Metathesis or Alkyne Cross Metathesis

The suitably functionalized cyclopentanone derivatives 12, 13, 19, and 37 serve as common precursors for the synthesis of various prostaglandins, prostaglandin-1,15-lactones, and unnatural analogues thereof. All of them contain a 2-butynyl entity which is elaborated into the intact α side chain of the targets either via a sequence comprising ring closing alkyne metathesis/Lindlar reduction or via alkyne cross metathesis (ACM)/Lindlar reduction. These novel approaches are distinguished by (i) the ready accessibility of the required cyclopentenone substrates via a three-component coupling reaction, (ii) the inherent flexibility which allows one to make a series of analogues starting from these common platforms, (iii) a small number of steps, and (iv) an excellent overall yield. The key alkyne metathesis reactions are efficiently catalyzed either by the tungsten alkylidyne complex (t-BuO)3W⋮CCMe3 or, preferentially, by a catalyst formed in situ from Mo[N(t-Bu)(Ar)]3 and CH2Cl2, the reactivity of which can be fine-tuned by varying the Ar substituent on the amido ligands. These organometallic tools exhibit a remarkable application profile, tolerate an array of polar groups, rigorously distinguish between different π-electron systems, and catalyze the reactions under conditions that are sufficiently mild to preserve even highly sensitive functionalities. The structures of the macrocyclic prostaglandin lactone derivatives 22 and 32 were characterized by X-ray crystallography

Epidemiological impact of waning immunization on a vaccinated population

This is an epidemiological SIRV model based study that is de- signed to analyze the impact of vaccination in containing infection spread, in a 4-tiered population compartment comprised of susceptible, infected, recov- ered and vaccinated agents. While many models assume a lifelong protection through vaccination, we focus on the impact of waning immunization due to conversion of vaccinated and recovered agents back to susceptible ones. Two asymptotic states exist, the \disease-free equilibrium" and the \endemic equi- librium" and we express the transitions between these states as function of the vaccination and conversion rates and using the basic reproduction number. We nd that the vaccination of newborns and adults have dierent consequences on controlling an epidemic. Also, a decaying disease protection within the re- covered sub-population is not sucient to trigger an epidemic on the linear level. We perform simulations for a parameter set modelling a disease with waning immunization like pertussis. For a diusively coupled population, a transition to the endemic state can proceed via the propagation of a traveling infection wave, described successfully within a Fisher-Kolmogorov framework

Eigenvectors under a generic perturbation: non-perturbative results from the random matrix approach

We consider eigenvectors of the Hamiltonian H0 perturbed by a generic perturbation V modelled by a random matrix from the Gaussian Unitary Ensemble (GUE). Using the super-symmetry approach we derive analytical results for the statistics of the eigenvectors, which are non-perturbative in V and valid for an arbitrary deterministic H0. Further we generalise them to the case of a random H0, focusing, in particular, on the Rosenzweig-Porter model. Our analytical predictions are confirmed by numerical simulations

Wytyczne dla laboratoriów genetyki nowotworów litych

Niniejsze wytyczne skierowane są do laboratoriów wykonujących diagnostyczne badania genetyczne technikami biologii molekularnej i cytogenetyki molekularnej (FISH) w zakresie genetyki nowotworów litych zarówno w obszarze zaburzeń genetycznych dziedzicznych, jak i nabytych. Diagnostyczne badanie genetyczne jest wykonywane w celu identyfikacji zaburzeń w DNA komórek człowieka. Przestrzeganie niniejszych zasad ma na celu zapewnienie wysokiego poziomu usług medycznych świadczonych przez laboratoria

Systemic Toll-Like Receptor Stimulation Suppresses Experimental Allergic Asthma and Autoimmune Diabetes in NOD Mice

BackgroundInfections may be associated with exacerbation of allergic and autoimmune diseases. Paradoxically, epidemiological and experimental data have shown that some microorganisms can also prevent these pathologies. This observation is at the origin of the hygiene hypothesis according to which the decline of infections in western countries is at the origin of the increased incidence of both Th1-mediated autoimmune diseases and Th2-mediated allergic diseases over the last decades. We have tested whether Toll-like receptor (TLR) stimulation can recapitulate the protective effect of infectious agents on allergy and autoimmunity. Methods and Findings Here, we performed a systematic study of the disease-modifying effects of a set of natural or synthetic TLR agonists using two experimental models, ovalbumin (OVA)-induced asthma and spontaneous autoimmune diabetes, presenting the same genetic background of the non obese diabetic mouse (NOD) that is highly susceptible to both pathologies. In the same models, we also investigated the effect of probiotics. Additionally, we examined the effect of the genetic invalidation of MyD88 on the development of allergic asthma and spontaneous diabetes. We demonstrate that multiple TLR agonists prevent from both allergy and autoimmunity when administered parenterally. Probiotics which stimulate TLRs also protect from these two diseases. The physiological relevance of these findings is further suggested by the major acceleration of OVA-induced asthma in MyD88 invalidated mice. Our results strongly indicate that the TLR-mediated effects involve immunoregulatory cytokines such as interleukin (IL)-10 and transforming growth factor (TGF)-β and different subsets of regulatory T cells, notably CD4+CD25+FoxP3+ T cells for TLR4 agonists and NKT cells for TLR3 agonists. Conclusions/Significance These observations demonstrate that systemic administration of TLR ligands can suppress both allergic and autoimmune responses. They provide a plausible explanation for the hygiene hypothesis. They also open new therapeutic perspectives for the prevention of these pathologies

Charged and Hydrophobic Surfaces on the A Chain of Shiga-Like Toxin 1 Recognize the C-Terminal Domain of Ribosomal Stalk Proteins

Shiga-like toxins are ribosome-inactivating proteins (RIP) produced by pathogenic E. coli strains that are responsible for hemorrhagic colitis and hemolytic uremic syndrome. The catalytic A1 chain of Shiga-like toxin 1 (SLT-1), a representative RIP, first docks onto a conserved peptide SD[D/E]DMGFGLFD located at the C-terminus of all three eukaryotic ribosomal stalk proteins and halts protein synthesis through the depurination of an adenine base in the sarcin-ricin loop of 28S rRNA. Here, we report that the A1 chain of SLT-1 rapidly binds to and dissociates from the C-terminal peptide with a monomeric dissociation constant of 13 µM. An alanine scan performed on the conserved peptide revealed that the SLT-1 A1 chain interacts with the anionic tripeptide DDD and the hydrophobic tetrapeptide motif FGLF within its sequence. Based on these 2 peptide motifs, SLT-1 A1 variants were generated that displayed decreased affinities for the stalk protein C-terminus and also correlated with reduced ribosome-inactivating activities in relation to the wild-type A1 chain. The toxin-peptide interaction and subsequent toxicity were shown to be mediated by cationic and hydrophobic docking surfaces on the SLT-1 catalytic domain. These docking surfaces are located on the opposite face of the catalytic cleft and suggest that the docking of the A1 chain to SDDDMGFGLFD may reorient its catalytic domain to face its RNA substrate. More importantly, both the delineated A1 chain ribosomal docking surfaces and the ribosomal peptide itself represent a target and a scaffold, respectively, for the design of generic inhibitors to block the action of RIPs

Infection kinetics of Covid-19 and containment strategy

The devastating trail of Covid-19 is characterized by one of the highest mortality-to-infected ratio for a pandemic. Restricted therapeutic and early-stage vaccination still renders social exclusion through lockdown as the key containment mode.To understand the dynamics, we propose PHIRVD, a mechanistic infection propagation model that Machine Learns (Bayesian Markov Chain Monte Carlo) the evolution of six infection stages, namely healthy susceptible (H), predisposed comorbid susceptible (P), infected (I), recovered (R), herd immunized (V) and mortality (D), providing a highly reliable mortality prediction profile for 18 countries at varying stages of lockdown. Training data between 10 February to 29 June 2020, PHIRVD can accurately predict mortality profile up to November 2020, including the second wave kinetics. The model also suggests mortality-to-infection ratio as a more dynamic pandemic descriptor, substituting reproduction number. PHIRVD establishes the importance of early and prolonged but strategic lockdown to contain future relapse, complementing futuristic vaccine impact